Healthcare Provider Details

I. General information

NPI: 1023325586
Provider Name (Legal Business Name): NEW HAMPSHIRE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2010
Last Update Date: 09/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PLEASANT ST PSYCHIATRIC RESEARCH CENTER, MAIN BUILDING
CONCORD NH
03301-3852
US

IV. Provider business mailing address

105 PLEASANT ST PSYCHIATRIC RESEARCH CENTER, MAIN BUILDING
CONCORD NH
03301-3852
US

V. Phone/Fax

Practice location:
  • Phone: 160-327-1574
  • Fax:
Mailing address:
  • Phone: 160-327-1574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number1075
License Number StateNH

VIII. Authorized Official

Name: DR. SUSAN R MCGURK
Title or Position: NEUROPSYCHOLOGIST
Credential: PH.D.
Phone: 603-271-5369